Overview of care provision for adolescents aged over 15 with a mental
state at risk in France
Abstract
Introduction Early detection and intervention in psychotic disorders are
public health issues that have led to the creation of specific care
systems in France, the visibility of which is still debated. Moreover,
these services are often concentrated in adult rather than child
psychiatry, which may increase the duration of untreated psychosis.
Methods The main objective of this study was to take stock of the care
provided in the adolescent unit of the Candélie hospital
(Lot-et-Garonne, France) in 2023 and the proportion of adolescents aged
over 15 diagnosed with a mental health condition at risk who were
followed up. The second objective was to propose an experimental
approach to improving care for this group of patients by introducing an
advanced practice nurse. Results The results of the retrospective study
carried out in 2022 show that staffing levels and care units in
adolescent medicine are saturated. Depending on the system, between 19%
and 39% of patients are classified as mentally vulnerable. The
construction of an Ishikawa diagram highlights three major issues on
which the advanced nurse practitioner could intervene: support for one
of the systems under particular pressure (RESEDA), the resumption of
part of the medical activities given the shortage of doctors, and the
child psychiatry-adult psychiatry relay. Conclusion Restructuring
existing systems to include initial consultation and monitoring of these
adolescents and their families by advanced practice nurses would reduce
the duration of untreated psychosis and allow earlier intervention with
these adolescents.